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 Official PayPal Seal

Credit Card Authorization Form

                      

1.Company Name


2.*NAME AS IT APPEARS ON THE CARD


3.CREDIT CARD TYPE (select one)


4.*Credit Card Number:


5.*Expiration date mm/yy


6.*CVV2


7.*Credit Card Billing Address  Including: Street address, City, State ZIP Code and Country. 



8.*Phone number


9.*Amount of purchase


10.*Your email address

By completing form cardholder authorizes POS OF AMERICA to debit the credit card information shown above. Cardholder also acknowledges that the information shown above is true and correct

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